Low HDL Cholesterol (“Good” Cholesterol)
What you will learn on this page
- What HDL (“good”) cholesterol is and why it matters
- What causes HDL levels to be low
- How statins and other medications affect HDL
- Which lifestyle and dietary changes can help improve it
- Why overall cardiovascular risk is more important than a single number
What is HDL cholesterol?
HDL stands for High Density Lipoprotein. It is often called “good cholesterol” because it helps remove excess cholesterol from the bloodstream and carries it back to the liver, where it can be processed and cleared.
Higher HDL levels are generally associated with a lower long-term risk of heart disease.
Why does low HDL matter?
Low HDL can be linked with an increased risk of cardiovascular disease (heart attack and stroke), particularly when combined with other risk factors such as:
- High LDL (“bad”) cholesterol
- High triglycerides
- Diabetes
- High blood pressure
- Smoking
- Excess weight
It is important to understand that we do not usually treat HDL on its own. Instead, we look at your overall cardiovascular risk and manage that appropriately.
I’m on a statin — does that affect HDL?
Statins are prescribed to lower LDL (“bad”) cholesterol and reduce heart risk.They may cause a small rise in HDL, but they are not primarily used to increase HDL.
If your HDL remains low while on a statin, this does not usually mean the treatment is failing. The most important factor is that your LDL and overall risk are controlled.
What can cause low HDL?
Common causes include:
- Lack of regular exercise
- Being overweight or having excess abdominal fat
- Smoking
- Insulin resistance or type 2 diabetes
- High triglycerides
- A diet high in refined carbohydrates and processed foods
Certain medications can also lower HDL, including:
- Some beta-blockers
- Anabolic steroids or testosterone misuse
- Progestogens in some contraceptives
- Some older lipid-lowering drugs
If we feel a medication is contributing, we can review this with you.
How can I improve my HDL naturally?
The most effective ways to improve HDL and reduce heart risk are lifestyle-based:
1. Regular aerobic exerciseBrisk walking, cycling, swimming or similar activity for at least 150 minutes per week can significantly improve HDL and overall heart health.
2. Maintain a healthy weightEven modest weight loss can improve HDL and triglycerides.
3. Stop smokingSmoking lowers HDL and damages blood vessels. Stopping can improve HDL within weeks.
4. Improve dietary qualityFocus on:
- Oily fish (salmon, mackerel, sardines)
- Nuts and seeds
- Olive oil
- Vegetables and whole foods
Reduce:
- Refined sugars
- White bread and processed carbohydrates
- Ultra-processed foods
Very low-fat diets are not usually helpful for HDL. Healthy fats are important.
Should I take medication to raise HDL?
Currently, medications designed purely to raise HDL have not been shown to reduce heart attack risk. Because of this, treatment focuses on:
- Lowering LDL cholesterol
- Controlling blood pressure
- Managing diabetes
- Encouraging lifestyle change
This approach has much stronger evidence for reducing long-term cardiovascular risk.
When should I be concerned?
Low HDL on its own is rarely an emergency. It becomes more relevant if you have:
- Diabetes
- High LDL cholesterol
- A strong family history of heart disease
- Established heart disease
If you would like your overall cardiovascular risk reviewed, please book a routine appointment.
